Organization Active NPI

Native Health

Doing business as Native American Community Health Center, Inc.

Federally Qualified Health Center (FQHC)
Phoenix, AZ

National Provider Identifier

1740462761

Registry record updated May 13, 2025

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Ownership & related parties
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Phoenix, AZ
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name: NATIVE HEALTH
Doing business as: Native American Community Health Center, Inc.
Practice address: 4041 N Central Ave BLDG C
Phoenix, AZ 85012-3313
Phone: (602) 279-5262
Fax: (602) 279-5390
NPI assigned: Nov 30, 2007
Last updated: May 13, 2025By the provider in NPPES
Organization subpart: Yes
Parent organization: NATIVE HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name: Mr. Walter Murillo
Title: Ceo
Phone: (602) 279-5262

Specialties & licenses 2

Specialty (taxonomy)	Code	License	State	Primary
Federally Qualified Health Center (FQHC)	261QF0400X			Primary
Mental Health Clinic/Center (Including Community Mental Health Center)	261QM0801X

Addresses

Primary practice location

4041 N Central Ave BLDG C
Phoenix, AZ 85012-3313

Mailing address

4041 N. Central Ave
Building C
Phoenix, AZ 85012-3313
Phone (602) 279-5262

Other practice location 1

777 W Southern Ave
Bldg E, Ste 501
Mesa, AZ 85210-5015
Phone (480) 550-4048

Other practice location 2

8800 N 22nd Ave
Phoenix, AZ 85021-4258
Phone (602) 279-5262

Other practice location 3

6725 S Priest Dr
Guadalupe, AZ 85283-4382
Phone (602) 279-5262

Other identifiers 1

Identifier	Type	State	Issuer
394932	Medicaid	AZ

Other names 1

Native American Community Health Center, Inc. Doing business as

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in AZ3 enrollments

Enrollment records 3

Enrollment ID	State	Provider type	PAC ID	Details
O20070920000529	AZ	Part A Provider - Federally Qualified Health Center (FQHC)	4385738418	3 other NPIs on this enrollment Practice locations: Phoenix, AZ
O20180319001101	AZ	Part B Supplier - Clinic/Group Practice	4385738418	Receives reassigned benefits from 24 practitioners 8 other NPIs on this enrollment Practice locations: Guadalupe, AZ; Mesa, AZ; Phoenix, AZ
O20190418001393	AZ	Part A Provider - Federally Qualified Health Center (FQHC)	4385738418	3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Phoenix, AZ

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1740462761. Details of each certification follow.

CCN 031879 Federally qualified health center · Active · Details
CCN 031825 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 031879

Legal name: NATIVE HEALTH
Doing business as: NATIVE AMERICAN COMMUNITY HEALTH CENTER, INC.
Certification status: Active
Provider type (POS): Federally qualified health center
Participating since: Oct 27, 2009
Last certification: Oct 27, 2009
Ownership / control type: Non-profit – church related
Organization structure: CorporationNon-profit
Incorporated: Jun 1, 1997 in AZ
Enrollment address: 2423 W Dunlap Ave
Ste 140
Phoenix, AZ 85021-5818

Federally qualified health center certification: CCN 031825

Legal name: NATIVE HEALTH
Doing business as: NATIVE AMERICAN COMMUNITY HEALTH CENTER, INC.
Certification status: Active
Provider type (POS): Federally qualified health center
Participating since: Jul 1, 1996
Last certification: Jul 1, 1996
Ownership / control type: For profit – corporation
Organization structure: CorporationNon-profit
Incorporated: Jun 1, 1997 in AZ
Enrollment address: 4041 N Central Ave
BLDG C
Phoenix, AZ 85012-3313

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1700904075
4385738418
Same PAC ID

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Mesa, AZ
- NPI 1336654383
O20180319001101
Same enrollment
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1427386853
O20180319001101, O20190418001393
Same enrollment
Native Health

dba Native American Community Health Center
- Federally Qualified Health Center (FQHC)
- Guadalupe, AZ
- NPI 1487443115
O20180319001101
Same enrollment
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1578059168
O20180319001101
Same enrollment
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1700904075
O20180319001101, O20190418001393
Same enrollment
Native Health

dba Native American Community Health Center, Inc.
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Phoenix, AZ
- NPI 1780121244
O20070920000529, O20180319001101, O20190418001393
Same enrollment
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1871972182
O20070920000529, O20180319001101
Same enrollment
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1982830410
O20070920000529, O20180319001101
Same enrollment

National Provider Directory

Part of: Native Health

Locations

4041 N Central Ave
Bldg D
Phoenix, AZ 85012

6850 W Indian School Rd
Phoenix, AZ 85033
Phone (623) 247-0464

6725 S Priest Dr
Tempe, AZ 85283
Phone (520) 879-6039

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Name	Role	Since
Cody Nelson Individual	Operational/Managerial ControlCfo	Oct 1, 2018
Cody Nelson Individual	Corporate OfficerChief Financial Officer	Oct 1, 2018
Olivia Wauneka Individual	Corporate DirectorBoard Member	Jun 18, 2019
John Molina Individual	Corporate OfficerCompliance Officer	Jan 12, 2017
Brianna Jajelski Individual	Corporate DirectorBoard Member	Jun 18, 2019
Christina Brown Individual	Corporate DirectorBoard Member	Jun 1, 2018
Carol Dahozy Individual	Corporate DirectorBoard Member	Jun 1, 2017
Francie Brown-Spencer Individual	Corporate OfficerFunds Development Officer	Mar 5, 2020
Francie Brown-Spencer Individual	Corporate OfficerChief Development Officer	Jan 4, 2024
Native Health Organization, Phoenix, AZ Corporation, Non-profit	Operational/Managerial Control	Aug 30, 1978
Deanna Sangster Individual	Corporate OfficerCoo	May 13, 2021
Deanna Sangster Individual	Corporate OfficerChief Operating Officer	Aug 13, 1992
Jeanine Edaakie Individual	Corporate DirectorBoard Member	Jun 1, 2018
Jeanine Edaakie Individual	Corporate OfficerBoard Vice President	Jun 1, 2018
Rishi Popat Individual	Corporate DirectorBoard Member	Jun 1, 2017
Rishi Popat Individual	Corporate OfficerBoard Member	Jun 1, 2017
Shawn Sellers Individual	Corporate DirectorBoard Member	Jun 1, 2017
Shawn Sellers Individual	Corporate OfficerBoard President	Jun 1, 2017
Tahnisha Sungino Individual	Corporate DirectorBoard Member	Jun 1, 2018
Walter R Murillo Individual	Operational/Managerial ControlCeo	May 31, 2011
	Corporate OfficerChief Executive Officer	Jun 28, 2010
	Operational/Managerial ControlChief Executive Officer	Jun 28, 2010
Elena Young Individual	Corporate DirectorBoard Member	Jun 1, 2017
Elena Young Individual	Corporate OfficerBoard Secretary	Jun 1, 2017
Mitchell Terry Individual	Corporate OfficerChief Compliance Officer	Dec 7, 2023
Vafa K Matin Individual	Corporate OfficerChief Medical Officer	Nov 30, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Vafa Matin, DO
- Family Medicine Physician
- Phoenix, AZ
- NPI 1184695371
Corporate Officer
CMS ownership
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1700904075
Operational/Managerial Control
CMS ownership

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Facility	Type	Role	Since
Native American Community Health Center, Inc.Phoenix, AZ, CCN 031825	Federally qualified health center	Operational/Managerial Control	Aug 30, 1978

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1427386853
Operational/Managerial Control
CMS ownership
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1700904075
Operational/Managerial Control
CMS ownership
Native Health

dba Native American Community Health Center, Inc.
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Phoenix, AZ
- NPI 1780121244
Operational/Managerial Control
CMS ownership
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1871972182
Operational/Managerial Control
CMS ownership
Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1982830410
Operational/Managerial Control
CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Native Health

dba Native American Community Health Center, Inc.
- Federally Qualified Health Center (FQHC)
- Phoenix, AZ
- NPI 1700904075
Native Health
CMS ownership

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Antontrey Begaye
- Family Medicine Physician
- Phoenix, AZ
- NPI 1083243422
Medicare reassignment Care Compare group NPD
Eric Carmen Betancourt, PMHNP-BC
- Psychiatric/Mental Health Nurse Practitioner
- Phoenix, AZ
- NPI 1578945572
Medicare reassignment Care Compare group NPD
Erica Carreon, FNP-BC
- Family Nurse Practitioner
- Guadalupe, AZ
- NPI 1902682248
Medicare reassignment Care Compare group NPD
Kyra Castillo
- Mental Health Counselor
- Glendale, AZ
- NPI 1750993234
Medicare reassignment Care Compare group NPD
Edwige Dea Djassa, FNP
- Family Nurse Practitioner
- Phoenix, AZ
- NPI 1780979625
Medicare reassignment Care Compare group NPD
Joy Lynne Golden, LCSW
- Clinical Social Worker
- Phoenix, AZ
- NPI 1104363183
Medicare reassignment Care Compare group NPD
Paul Ace Jim III, LCSW
- Clinical Social Worker
- Mesa, AZ
- NPI 1154791580
Medicare reassignment Care Compare group NPD
Vafa Matin, DO
- Family Medicine Physician
- Phoenix, AZ
- NPI 1184695371
Medicare reassignment Care Compare group NPD
Kayla Grace Rausch, FNP
- Family Nurse Practitioner
- Phoenix, AZ
- NPI 1790206688
Medicare reassignment Care Compare group NPD
Maggie Talamantes
- Psychiatric/Mental Health Nurse Practitioner
- Phoenix, AZ
- NPI 1093540866
Multi-Specialty
Medicare reassignment Care Compare group NPD
Lawanda Wheat, FNP-C
- Family Nurse Practitioner
- Tempe, AZ
- NPI 1609541333
Medicare reassignment Care Compare group NPD
Janice Yazzie, LPC
- Professional Counselor
- Mesa, AZ
- NPI 1356077242
Medicare reassignment Care Compare group NPD

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1740462761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 N. CENTRAL AVE",
            "address_2": "BUILDING C",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850123313",
            "telephone_number": "602-279-5262",
            "fax_number": "602-279-5390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 N CENTRAL AVE BLDG C",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850123313",
            "telephone_number": "602-279-5262",
            "fax_number": "602-279-5390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "777 W Southern Ave",
            "address_2": "Bldg E, Ste 501",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852105015",
            "country_code": "US",
            "telephone_number": "480-550-4048",
            "fax_number": "480-264-5099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8800 N 22nd Ave",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850214258",
            "country_code": "US",
            "telephone_number": "602-279-5262",
            "fax_number": "602-279-5361",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6725 S Priest Dr",
            "address_purpose": "LOCATION",
            "city": "Guadalupe",
            "state": "AZ",
            "postal_code": "852834382",
            "country_code": "US",
            "telephone_number": "602-279-5262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NATIVE HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NATIVE HEALTH",
        "enumeration_date": "2007-11-30",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "MURILLO",
        "authorized_official_first_name": "WALTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-279-5262",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "394932",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Native American Community Health Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.